Continuous subcutaneous infusion - Revision history

ClaireLewis at 13:25, 7 October 2019

2019-10-07T13:25:45Z

← Older revision		Revision as of 13:25, 7 October 2019
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	==Comparative Dosing==		==Comparative Dosing==
	*Dexamethasone: 4mg orally = 4mg SC (use as stat doses)		*[[Dexamethasone]]: 4mg orally = 4mg SC (use as stat doses)
	*Diclofenac: 150mg oral = 75mg SC (use only as CSCI as tissue necrosis has been reported with stat doses)		*[[Diclofenac]]: 150mg oral = 75mg SC (use only as CSCI as tissue necrosis has been reported with stat doses)
	*[[Haloperidol]]: 2mg oral = 1mg SC		*[[Haloperidol]]: 2mg oral = 1mg SC
	*Hydromorphone: 3mg oral = 1mg SC		*[[Hydromorphone]]: 3mg oral = 1mg SC
	*Levetiracetam: 250mg oral = 250mg SC (use only as CSCI)		*[[Levetiracetam]]: 250mg oral = 250mg SC (use only as CSCI)
	*Levomepromazine: 25mg oral = 12.5mg SC		*Levomepromazine: 25mg oral = 12.5mg SC
	*Methadone: 10mg oral = 5mg SC (typically used as a stat dose rather than via CSCI)		*[[Methadone]]: 10mg oral = 5mg SC (typically used as a stat dose rather than via CSCI)
	*Morphine: 30mg oral = 10mg SC (use as stat doses for break-through pain and via CSCI for background pain)		*[[Morphine]]: 30mg oral = 10mg SC (use as stat doses for break-through pain and via CSCI for background pain)
	*Ondansetron: 8mg oral = 4mg SC (typically used as a stat dose rather than via CSCI)		*[[Ondansetron]]: 8mg oral = 4mg SC (typically used as a stat dose rather than via CSCI)
	*Oxycodone: 10mg oral = 5mg SC (use as stat doses for break-through pain and via CSCI for background pain)		*[[Oxycodone]]: 10mg oral = 5mg SC (use as stat doses for break-through pain and via CSCI for background pain)
	*Ranitidine: 100mg oral = 50mg SC		*[[Ranitidine]]: 100mg oral = 50mg SC
	*Valproate: 200mg oral = 200mg SC (use as CSCI)		*[[Valproate]]: 200mg oral = 200mg SC (use as CSCI)

	==Combinations==		==Combinations==

Neil.m.young: Text replacement - "* " to "*"

2016-07-04T23:18:37Z

Text replacement - "* " to "*"

← Older revision		Revision as of 23:18, 4 July 2016
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	==Comparative Dosing==		==Comparative Dosing==
	* Dexamethasone: 4mg orally = 4mg SC (use as stat doses)		*Dexamethasone: 4mg orally = 4mg SC (use as stat doses)
	* Diclofenac: 150mg oral = 75mg SC (use only as CSCI as tissue necrosis has been reported with stat doses)		*Diclofenac: 150mg oral = 75mg SC (use only as CSCI as tissue necrosis has been reported with stat doses)
	* [[Haloperidol]]: 2mg oral = 1mg SC		*[[Haloperidol]]: 2mg oral = 1mg SC
	* Hydromorphone: 3mg oral = 1mg SC		*Hydromorphone: 3mg oral = 1mg SC
	* Levetiracetam: 250mg oral = 250mg SC (use only as CSCI)		*Levetiracetam: 250mg oral = 250mg SC (use only as CSCI)
	* Levomepromazine: 25mg oral = 12.5mg SC		*Levomepromazine: 25mg oral = 12.5mg SC
	* Methadone: 10mg oral = 5mg SC (typically used as a stat dose rather than via CSCI)		*Methadone: 10mg oral = 5mg SC (typically used as a stat dose rather than via CSCI)
	* Morphine: 30mg oral = 10mg SC (use as stat doses for break-through pain and via CSCI for background pain)		*Morphine: 30mg oral = 10mg SC (use as stat doses for break-through pain and via CSCI for background pain)
	* Ondansetron: 8mg oral = 4mg SC (typically used as a stat dose rather than via CSCI)		*Ondansetron: 8mg oral = 4mg SC (typically used as a stat dose rather than via CSCI)
	* Oxycodone: 10mg oral = 5mg SC (use as stat doses for break-through pain and via CSCI for background pain)		*Oxycodone: 10mg oral = 5mg SC (use as stat doses for break-through pain and via CSCI for background pain)
	* Ranitidine: 100mg oral = 50mg SC		*Ranitidine: 100mg oral = 50mg SC
	* Valproate: 200mg oral = 200mg SC (use as CSCI)		*Valproate: 200mg oral = 200mg SC (use as CSCI)

	==Combinations==		==Combinations==
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	'''Some common compatible combinations include:'''		'''Some common compatible combinations include:'''
	* Morphine (or oxycodone) plus		*Morphine (or oxycodone) plus
	** Haloperidol		**Haloperidol
	** Levomepromazine		**Levomepromazine
	** Metoclopramide		**Metoclopramide
	** Haloperidol plus hyoscine butylbromide		**Haloperidol plus hyoscine butylbromide
	** Haloperidol plus midazolam		**Haloperidol plus midazolam
	** Haloperidol plus octreotide		**Haloperidol plus octreotide
	** Haloperidol plus midazolam plus hyoscine butylbromide		**Haloperidol plus midazolam plus hyoscine butylbromide
	** Haloperidol plus midazolam plus metoclopramide		**Haloperidol plus midazolam plus metoclopramide
	** Haloperidol plus midazolam plus hyoscine butylbromide		**Haloperidol plus midazolam plus hyoscine butylbromide
	* Fentanyl plus		*Fentanyl plus
	** Haloperidol		**Haloperidol
	** Hyoscine butylbromide		**Hyoscine butylbromide
	** Metoclopramide		**Metoclopramide
	** Haloperidol plus midazolam		**Haloperidol plus midazolam
	** Haloperidol plus midaozolam plus hyoscine butylbromide		**Haloperidol plus midaozolam plus hyoscine butylbromide
	* Opioid-free combinations		*Opioid-free combinations
	** Haloperidol plus ondansetron		**Haloperidol plus ondansetron
	** Haloperidol plus hyoscine butylbromide plus octreotide plus ranitidine		**Haloperidol plus hyoscine butylbromide plus octreotide plus ranitidine

	==See Also==		==See Also==

Rossdonaldson1: Rossdonaldson1 moved page Continuous Subcutaneous Infusion (CSCI) to Continuous subcutaneous infusion

2015-09-08T14:28:27Z

Rossdonaldson1 moved page Continuous Subcutaneous Infusion (CSCI) to Continuous subcutaneous infusion

← Older revision	Revision as of 14:28, 8 September 2015
(No difference)

Rossdonaldson1: /* Background */

2015-09-08T14:28:07Z

Background

← Older revision		Revision as of 14:28, 8 September 2015
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	==Background==		==Background==
			*Abbreviation: CSCI
	*Common method of medication administration in palliative medicine, especially for patients near the end of their life.		*Common method of medication administration in palliative medicine, especially for patients near the end of their life.
	*These patients typically require parenteral medications as they lose the ability to take PO meds.		*These patients typically require parenteral medications as they lose the ability to take PO meds.

Mholtz: Formatting changes, some new content

2015-09-06T08:01:52Z

Formatting changes, some new content

← Older revision		Revision as of 08:01, 6 September 2015
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	~~CSCI stands for Continuous Subcutaneous Infusion and is a common~~ method of administration ~~of medications~~ in palliative medicine, especially for patients near the end of their life. ~~It is~~ typically ~~used~~ in ~~preference~~ to ~~the~~ IV ~~route it is a simpler~~ method of administration ~~and seen~~ as kinder.		==Background==
			*Common method of medication administration in palliative medicine, especially for patients near the end of their life.
			*These patients typically require parenteral medications as they lose the ability to take PO meds.
			*Subcutaneous route has many advantages over IV<ref name="Gabriel">Gabriel J., The use of subcutaneous infusion in medication administration. Br J Nurs. 2013 Jul 25-Aug 7;22(14):S6, S8, S10 passim.</ref>
			**No risk of phlebitis or air embolus
			**Allows patient to retain more mobility (IV site typically on hand or arm; subcutaneous sites include chest, thigh, abdomen)
			**More comfortable for patient
			**Less susceptible to occlusion or dislodgement
			**Simpler method of administration
			**Seen as kinder

	== Indications ==		==Indications==
			Generally used when oral route is unavailable, e.g.<ref name="Menahem">Menahem S, Shvartzman P. Continuous subcutaneous delivery of medications for home care palliative patients-using an infusion set or a pump? Support Care Cancer. 2010 Sep;18(9):1165-70.</ref>
	~~Use~~ when ~~the~~ oral route is unavailable, e.g.		*Weakness, drowsiness or coma
	* ~~In patients too drowsy to swallow~~		*Severe nausea/vomiting
	* ~~In patients who are~~ vomiting		*Severe dysphagia

	~~== Comparative dosing ==~~

			==Comparative Dosing==
	* Dexamethasone: 4mg orally = 4mg SC (use as stat doses)		* Dexamethasone: 4mg orally = 4mg SC (use as stat doses)
	* Diclofenac: 150mg oral = 75mg SC (use only as CSCI as tissue necrosis has been reported with stat doses)		* Diclofenac: 150mg oral = 75mg SC (use only as CSCI as tissue necrosis has been reported with stat doses)
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	* Valproate: 200mg oral = 200mg SC (use as CSCI)		* Valproate: 200mg oral = 200mg SC (use as CSCI)

	== Combinations ==		==Combinations==

	Mixing mediations in subcutaneous infusions can cause problems if there are drug incompatibilities that cause reactions. Look for crystallization when mixing medications.		Mixing mediations in subcutaneous infusions can cause problems if there are drug incompatibilities that cause reactions. Look for crystallization when mixing medications.

	Some common compatible combinations ~~are noted below~~:		'''Some common compatible combinations include:'''
	* Morphine (or oxycodone) plus		* Morphine (or oxycodone) plus
	** Haloperidol		** Haloperidol
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	** Haloperidol plus hyoscine butylbromide plus octreotide plus ranitidine		** Haloperidol plus hyoscine butylbromide plus octreotide plus ranitidine

	==~~Clinical example~~==		==See Also==

	A patient on 50mg twice daily MR oxycodone and 10mg three times daily of oral metoclopramide for bony pain from metastatic prostate cancer presents to the Emergency Department with vomiting following chemotherapy. His pain has flared up because he is vomiting up his oxycodone. To ensure he continues to receive his pain relief and to ensure he receives anti-emetics, a continuous subcutaneous infusion of analgesia is commenced.

	~~Current outpatient regimen is converted to a subcutaneous regimen~~
	*50mg of twice daily MR oxycodone = 100 mg of oral oxycodone daily = 50mg of SC oxycodone daily
	*30mg of oral metoclopramide daily = 30mg of SC metoclopramide daily

	~~A slight dose reduction of oxycodone is used as the 2:1 ratio of oral to SC varies from person to person. Thus the pump is started at:~~		==References==
	*Oxycodone 40mg via CSCI over 24 hours AND		<References/>
	*[[Metoclopramide]] 30mg via CSCI over 24 hours

	[[Category:Palliative Medicine]]		[[Category:Palliative Medicine]]

Ostermayer: /* Comparative dosing */

2015-09-04T16:57:25Z

Comparative dosing

← Older revision		Revision as of 16:57, 4 September 2015
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	* Dexamethasone: 4mg orally = 4mg SC (use as stat doses)		* Dexamethasone: 4mg orally = 4mg SC (use as stat doses)
	* Diclofenac: 150mg oral = 75mg SC (use only as CSCI as tissue necrosis has been reported with stat doses)		* Diclofenac: 150mg oral = 75mg SC (use only as CSCI as tissue necrosis has been reported with stat doses)
	* Haloperidol: 2mg oral = 1mg SC		* [[Haloperidol]]: 2mg oral = 1mg SC
	* Hydromorphone: 3mg oral = 1mg SC		* Hydromorphone: 3mg oral = 1mg SC
	* Levetiracetam: 250mg oral = 250mg SC (use only as CSCI)		* Levetiracetam: 250mg oral = 250mg SC (use only as CSCI)

Ostermayer: /* Clinical example */

2015-09-04T16:56:57Z

Clinical example

← Older revision		Revision as of 16:56, 4 September 2015
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	A patient on 50mg twice daily MR oxycodone and 10mg three times daily of oral metoclopramide for bony pain from metastatic prostate cancer presents to the Emergency Department with vomiting following chemotherapy. His pain has flared up because he is vomiting up his oxycodone. To ensure he continues to receive his pain relief and to ensure he receives anti-emetics, a continuous subcutaneous infusion of analgesia is commenced.		A patient on 50mg twice daily MR oxycodone and 10mg three times daily of oral metoclopramide for bony pain from metastatic prostate cancer presents to the Emergency Department with vomiting following chemotherapy. His pain has flared up because he is vomiting up his oxycodone. To ensure he continues to receive his pain relief and to ensure he receives anti-emetics, a continuous subcutaneous infusion of analgesia is commenced.

	~~Now,~~		Current outpatient regimen is converted to a subcutaneous regimen

	*50mg of twice daily MR oxycodone = 100 mg of oral oxycodone daily = 50mg of SC oxycodone daily		*50mg of twice daily MR oxycodone = 100 mg of oral oxycodone daily = 50mg of SC oxycodone daily
	~~And~~
	*30mg of oral metoclopramide daily = 30mg of SC metoclopramide daily		*30mg of oral metoclopramide daily = 30mg of SC metoclopramide daily

	A slight dose reduction of oxycodone is used as the 2:1 ratio of oral to SC varies from person to person. Thus the pump is started at:		A slight dose reduction of oxycodone is used as the 2:1 ratio of oral to SC varies from person to person. Thus the pump is started at:

	*Oxycodone 40mg via CSCI over 24 hours AND		*Oxycodone 40mg via CSCI over 24 hours AND
	*[[Metoclopramide]] 30mg via CSCI over 24 hours		*[[Metoclopramide]] 30mg via CSCI over 24 hours

	[[Category:Palliative Medicine]]		[[Category:Palliative Medicine]]

Graham.grove: /* Clinical example */ Spelling error fixed

2015-09-04T16:10:30Z

Clinical example: Spelling error fixed

← Older revision		Revision as of 16:10, 4 September 2015
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	==Clinical example==		==Clinical example==

	A patient on 50mg twice daily MR ~~oxyocodone~~ and 10mg three times daily of oral metoclopramide for bony pain from metastatic prostate cancer presents to the Emergency Department with vomiting following chemotherapy. His pain has flared up because he is vomiting up his oxycodone. To ensure he continues to receive his pain relief and to ensure he receives anti-emetics, a continuous subcutaneous infusion of analgesia is commenced.		A patient on 50mg twice daily MR oxycodone and 10mg three times daily of oral metoclopramide for bony pain from metastatic prostate cancer presents to the Emergency Department with vomiting following chemotherapy. His pain has flared up because he is vomiting up his oxycodone. To ensure he continues to receive his pain relief and to ensure he receives anti-emetics, a continuous subcutaneous infusion of analgesia is commenced.

	Now,		Now,

Ostermayer: Ostermayer moved page CSCI to Continuous Subcutaneous Infusion (CSCI)

2015-09-04T16:05:17Z

Ostermayer moved page CSCI to Continuous Subcutaneous Infusion (CSCI)

← Older revision	Revision as of 16:05, 4 September 2015
(No difference)

Ostermayer: /* Worked example */

2015-09-04T16:04:12Z

Worked example

← Older revision		Revision as of 16:04, 4 September 2015
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	** Haloperidol plus hyoscine butylbromide plus octreotide plus ranitidine		** Haloperidol plus hyoscine butylbromide plus octreotide plus ranitidine

	== ~~Worked~~ example ==		==Clinical example==

	A patient on 50mg twice daily MR oxyocodone and 10mg three times daily of oral metoclopramide for bony pain from metastatic prostate cancer presents to the Emergency Department with vomiting following chemotherapy. His pain has flared up because he is vomiting up his oxycodone. To ensure he continues to receive his pain relief and to ensure he receives anti-emetics, a continuous subcutaneous infusion of analgesia is commenced.		A patient on 50mg twice daily MR oxyocodone and 10mg three times daily of oral metoclopramide for bony pain from metastatic prostate cancer presents to the Emergency Department with vomiting following chemotherapy. His pain has flared up because he is vomiting up his oxycodone. To ensure he continues to receive his pain relief and to ensure he receives anti-emetics, a continuous subcutaneous infusion of analgesia is commenced.